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Prostate Cancer is the second most common cancer diagnosed in men worldwide. (1)

Prostate Cancer treatment options

 Various management options are available including surgery, radiation, and medications. Shared-decision making between healthcare providers and patients is key to choosing a prostate cancer management plan that helps promote patient satisfaction and the patient’s desired quality of life.

 One common medication option in the treatment of metastatic prostate cancer is androgen deprivation therapy (ADT).  While ADT therapy often normalizes serum levels of prostate-specific antigen and helps reduce patient symptoms such as bone pain; the response of the duration to ADT is variable.  If the prostate cancer progresses while on ADT, the patient is termed to have castration-resistant disease. (1)

Abiraterone acetate

Abiraterone acetate, commonly known under the brand name Zytiga; is a chemotherapy drug commonly used in conjunction with prednisone to treat men with metastatic prostate cancer. Abiraterone acetate is a CYP17 inhibitor, which blocks the conversion of androgen precursors in the testes, adrenal glands, and prostate tumor tissues. Abiraterone acetate lowers the amount of testosterone produced by the body.  As a result of decreased testosterone, the prostate cancer may shrink or decrease its growth.

Abiraterone acetate/Prednisone + ADT

 In recent years, Abiraterone acetate with prednisone and ADT have been found to be more beneficial compared to mono or dual treatment.  The LATITUDE study was a phase III randomized, multicenter, Clinical Trial published in 2017. The trial assessed the efficacy of abiraterone acetate and prednisone with androgen deprivation therapy (ADT) in men who were newly-diagnosed with castration sensitive, metastatic prostate cancer.  Almost 1200 men were included in the trial; where they randomly received 1 of 2 treatment options; androgen deprivation therapy with abiraterone and prednisone, versus androgen deprivation therapy with dual placebos.  Results showed that abiraterone with prednisone and androgen deprivation therapy led to significant improvement in overall survival and radiographic progression-free survival. (2)  

African-American Men

 African American men have the highest incidence of prostate cancer compared to other ethnicities.  A recent study found that African-American men with metastatic castration-resistant prostate cancer, not previously treated with chemotherapy, had better overall survival compared to Caucasians when treated with abiraterone acetate. (3)

Further investigation of ethnic disparities and other barriers in attaining hormone therapy drugs would be beneficial to further treatment of advanced prostate cancer in African American men 

References:

  1. Dawson N, Leger P. Initial systemic therapy for castration-sensitive prostate cancer. UpToDate. https://www.uptodate.com/contents/initial-systemic-therapy-for-castration-sensitive-prostate-cancer?search=abiraterone+acetate+prostate+cancer. Published 2020. Accessed August 14, 2020.
  1. Fizazi K, Tran N, Fein L, et al. Abiraterone acetate plus prednisone in patients with newly diagnosed high-risk metastatic castration-sensitive prostate cancer (LATITUDE): final overall survival analysis of a randomized, double-blind, phase 3 trial. The Lancet Oncology. 2019;20(5):686-700. doi:10.1016/S1470-2045(19)30082-8
  1. Mcnamara MA, George DJ, Ramaswamy K, et al. Overall survival by race in chemotherapy-naïve metastatic castration-resistant prostate cancer (mCRPC) patients treated with abiraterone acetate or enzalutamide. Journal of Clinical Oncology. 2019;37(7_suppl):212-212. doi:10.1200/jco.2019.37.7_suppl.212